Provider Demographics
NPI:1346881992
Name:SUTEK, IVY NOEL (CSAC)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:NOEL
Last Name:SUTEK
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 CLEVELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143
Mailing Address - Country:US
Mailing Address - Phone:715-732-6868
Mailing Address - Fax:715-732-6866
Practice Address - Street 1:1557 CLEVELAND AVENUE
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143
Practice Address - Country:US
Practice Address - Phone:715-732-6868
Practice Address - Fax:715-732-6866
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01960101YA0400X
WI17091-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI18963130OtherSTATE OF WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES